MedRisk by the Numbers
MedRisk is the largest specialty managed care organization in the workers’ compensation industry that is dedicated to physical rehabilitation.
Welcome to the third annual Industry Trends Report for Physical Medicine in Workers’ Compensation. As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk has always been dedicated to understanding and advancing best practices. By sharing the most meaningful changes we’ve seen in the wider community over the last year and the insights into where PT for workers’ comp is going next, we hope to make an even larger impact on increasing patient-focused care and improving return-to-work success for patients, providers and employers alike.
MedRisk is the largest specialty managed care organization in the workers’ compensation industry that is dedicated to physical rehabilitation.
Injured Workers Treated in 2019
to initial evaluation
U.S. BASED Service Model
PATIENT SATISFACTION
of network providers agree with our clinical Recommendations
TOTAL Network Providers
More visits per patient than Group Health
More likely to receive PT than Group Health
More modalities per visit than Group Health
The total cost of physical therapy in workers’ compensation is almost three times higher than in group health. But it’s not just the unit cost that’s driving these numbers, it’s the quantity of care (utilization). Workers’ comp patients are not only 45% more likely to receive PT but they receive 50% more visits and 20% more modalities per visit compared to group health patients according to recent research by NCCI.
While there is a modest unit price differential (105% more for workers’ comp than group health), the utilization of physical medicine in workers’ comp is 268% that of group health, making up the vast majority of the total cost differential.
Physical rehabilitation is a critical element of restoring functionality after a work-related injury and ensuring safe return to work but in an industry without cost-sharing mechanisms or co-pays, it is just as critical that the quality care is both effective and efficient. To tackle the cost-of-care challenge, therefore, it is critical to look at not just unit cost but the volume of service.
Duration (Days)
visits
From 2015 to 2018, MedRisk saw a 11.19% reduction in number of visits per case on average, driven by a combination of factors including quality management practices such as the application of evidence-based guidelines, expert providers, PT-to-PT coaching and clinical recommendations. The duration of care was also down by 24.97%. While controlling visits has an impact on duration of care, technology and electronic integration also speed authorization, facilitate communication and promote faster time to treatment. A steady decline in the percentage of more complex post-surgical cases is also a contributing factor.
* Includes both surgical and non-surgical closed cases from 1/1/2015 to 9/30/2019.
The conservative care movement continues to make an impact throughout the industry. Changes such as Ohio’s PT-first mandate and tighter utilization review controls in California have significantly decreased surgeries and, consequently, post-surgical PT. As such, MedRisk has seen post-surgical cases drop by 26% in the last 5 years. Could this be an early sign that PT is gaining traction as a preventative treatment strategy?
MedRisk gathers the latest legislative and regulatory developments and challenges each quarter. Here is a full summary of significant movements in 2019 and the implications for 2020.